Abstract
As per recommendation from WHO, Bangladesh began a comprehensive plan for AFP (Acute Flaccid Paralysis) and EPI (Expanded Program on Immunisation) disease surveillance from 1997. The country has been maintaining key performance indicators for AFP surveillance for the past ten years. Bangladesh has been declared polio free on 27th March 2014. The aim of this paper is to evaluate and describe results of AFP surveillance indicators for Bangladesh showing the progress made over time as well as identifying areas, which needs further improvements to maintain the polio free status. This retrospective study has been conducted using the surveillance data routinely collected from AFP cases on demographic characteristics and clinical & laboratory examination. Data of 7480 children less than 15 years old reported between January 2011 to December 2015 have been included in this study. Among all reported cases 59.22% cases were male children with a male: female ratio of 1.45:1. 54% of the reported AFP cases within the study period belong to 1-4 years of age. Among all reported cases, 56% have been diagnosed with Guillain-Barre Syndrome or GBS. Annual Non-Polio AFP rate has been successfully achieved nationally for each study year. Completeness and Timeliness of passive reporting from facilities have been satisfactory. 98% or more of all reported AFP cases within the study period has been investigated within 48 hours of notification. For over 95% of all reported AFP cases two stool samples were collected within 14 days of case reporting. 60 plus day follow up has been performed for at least 99% reported AFP cases within the study period. All epidemiological and laboratory surveillance indicators were successfully met for AFP surveillance. However it is important for Bangladesh to maintain long-term AFP case based surveillance along with introduction of Environmental surveillance due to the risk of poliovirus importation before global polio eradication.
Highlights
During World Health assembly held in May 1988, ministers of all WHO member countries voted to launch a global program to eradicate poliomyelitis
Considering all finding and analysis of Acute Flaccid Paralysis (AFP) surveillance performance indicators this study has come to a conclusion that AFP surveillance activities have been satisfactory in Bangladesh from 2011-2015
In addition to maintain this best practice, this study suggests the country taking the step to contribute in global polio eradication
Summary
During World Health assembly held in May 1988, ministers of all WHO member countries voted to launch a global program to eradicate poliomyelitis. The incidence of polio cases decreased by 99% globally and soon three WHO regions (Americans, Western pacific and European) were certified polio-free [1]. In WHO South-East Asian Region (SEAR) intensive polio eradication program using tOPV has lead to substantial decrease in number of polio cases and eleven countries of this region have been declared polio free on 27th March 2014 [2]. Bangladesh, one of the eleven member countries of WHO South-East Asian Region (SEAR), is the eight most populated country in the world and fifth most populated in Asia [3]. The country is a role model for the world for its achievements in immunisation program, which started as Expanded Program on Immunisation or EPI in 1979. The country has achieved an impressive 92.3% crude fully vaccinated rate by 2014 from a crude fully vaccinated rate of 76% in 1995 [5]
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